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Health and Social Care (Re-Committed) Bill: the NHS Future Forum and the Committee Stage Report Bill 221 of 2010-12 RESEARCH PAPER 11/63 30 August 2011

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Health and Social Care (Re-Committed) Bill: the NHS Future Forum and the Committee Stage Report Bill 221 of 2010-12 RESEARCH PAPER 11/63 30 August 2011 \ Health and Social Care (Re-committed) Bill: the NHS Future Forum and the Committee Stage Report Bill 221 of 2010-12 RESEARCH PAPER 11/63 30 August 2011 On 21 June 2011 the House agreed a motion re-committing certain clauses of the Health and Social Care Bill to the Public Bill Committee that had previously considered the Bill. The Committee met between 28 June and 14 July 2011 and agreed a number of Government amendments, introduced in response to the recommendations the ‘NHS Future Forum’. Key changes are intended to clarify the Secretary of State for Health’s overall responsibility for the NHS, to ensure good governance for the new groups that will be responsible for commissioning NHS-funded services, to strengthen duties to involve the public and health professionals in decision making, and to amend duties in relation to the role of competition and integration in the health service. The Bill is due to have its Report stage and Third Reading on 6 and 7 September 2011. Thomas Powell Recent Research Papers 11/53 Legal Aid, Sentencing and Punishment of Offenders Bill [Bill 205 of 2010- 27.06.11 12] 11/54 Protection of Freedoms Bill: Committee Stage Report 28.06.11 11/55 Economic Indicators, July 2011 05.07.11 11/56 Police (Detention and Bail) Bill [Bill 216 of 2010-12] 05.07.11 11/57 Sovereign Grant Bill [Bill 213 of 2010-12] 12.07.11 11/58 Unemployment by Constituency, July 2011 13.07.11 11/59 Economic Indicators, August 2011 02.08.11 11/60 Unemployment by Constituency, August 2011 17.08.11 11/61 London Olympic Games and Paralympic Games (Amendment) Bill: 22.08.11 Committee Stage Report 11/62 Terrorism Prevention and Investigation Measures Bill: Committee Stage 24.08.11 Report Research Paper 11/63 Contributing Authors: Thomas Powell, Social Policy Section This information is provided to Members of Parliament in support of their parliamentary duties and is not intended to address the specific circumstances of any particular individual. It should not be relied upon as being up to date; the law or policies may have changed since it was last updated; and it should not be relied upon as legal or professional advice or as a substitute for it. A suitably qualified professional should be consulted if specific advice or information is required. This information is provided subject to our general terms and conditions which are available online or may be provided on request in hard copy. Authors are available to discuss the content of this briefing with Members and their staff, but not with the general public. We welcome comments on our papers; these should be e-mailed to [email protected]. ISSN 1368-8456 Contents Summary 1 1 The NHS Future Forum and the listening exercise 3 1.1 The Government’s response 4 2 Re-committal of the Bill 5 Precedents for re-committal 6 3 The Committee stage on the Re-committed Bill 6 3.1 Evidence to the Committee 7 4 Amendments and debates on clauses 7 4.1 The Secretary of State’s powers and duties 8 The Secretary of State’s duty to provide or secure health services 8 Other Amendments 10 4.2 The NHS Commissioning Board and Clinical Commissioning Groups 10 Duty to promote NHS Constitution 10 Duty to promote patient and public involvement 11 Duty to promote integration 12 Wider clinical and public involvement in commissioning 13 Other Amendments 15 4.3 Competition and economic regulation 18 Monitor: competition and integration 18 Monitor: patient, public and clinical involvement 19 Variation in public and private sector provision of health services 20 Cherry picking 20 Other Amendments and debates on competition and economic regulation 22 4.4 Other Amendments 24 5 The timetable for change 25 Appendix 1 – Core recommendations of the NHS Future Forum 29 Appendix 2 – Members of the Public Bill Committee 32 Appendix 3 – Witnesses to Public Bill Committee oral evidence sessions 33 Tables No table of figures entries found. RESEARCH PAPER 11/63 Summary The Government unveiled an extensive package of reforms to the NHS in England in its July 2010 White Paper Equity and excellence: Liberating the NHS. The White Paper set out the Government’s aims to reduce central control of the NHS, to engage doctors in the commissioning of health services, and to give patients greater choice. The Health and Social Care Bill, published on 19 January 2011, would give effect to those reforms requiring primary legislation. Measures include giving groups of General Practitioners responsibility for commissioning the majority of health services, the creation of an independent NHS Commissioning Board, and giving local authorities responsibilities for coordinating local NHS services, social care and health improvement. The Bill establishes Monitor as an economic regulator for the health sector, and the Bill, as introduced, would have given Monitor a duty to promote competition between providers of NHS-funded services. While there was general agreement with the overall aims of the White Paper, there were significant concerns about a number of the Government’s specific proposals for reform, particularly around the accountability and governance arrangements for commissioners and providers of health services, and the role of competition in the NHS. Following the Bill’s first Committee stage, the Secretary of State for Health, Andrew Lansley, took the unusual step of announcing a pause in the legislation to conduct a ‘listening exercise’. The Government appointed a group of experts from across health and social care, known as the NHS Future Forum, to listen to concerns and report back to Government. The Future Forum concluded its eight-week listening exercise on 31 May 2011 and reported its findings on 13 June 2011. It made a number of detailed recommendations for changes to the Government’s reforms and legislation, including that the Bill should be amended to make clear the following. • The Secretary of State remains ultimately accountable for the NHS. • GP commissioning consortia should be required to obtain “multi‐professional advice” and be more accountable to the public. • The legislation should strengthen the role of local council health and wellbeing boards in the commissioning process. • Monitor’s role in relation to competition should be significantly diluted in the Bill with additional safeguards brought forward to prevent private providers from ‘cherry picking’ patients. The Government accepted the core recommendations of the NHS Future Forum and announced that the Bill would be partially re-committed, with certain clauses to be considered again by the Public Bill Committee that had previously scrutinised the whole Bill. The Committee held 12 sittings, meeting between 28 June and 14 July 2011. The Committee agreed Government amendments to clauses relating to the responsibility of the Secretary of State for Health for providing a comprehensive health service, and to the governance arrangements for commissioning groups. The Government announced that in future GP commissioning consortia would be known as ‘clinical commissioning groups’ (CCGs), with governing bodies to include at least one nurse and one specialist doctor. In addition, CCGs would be supported by clinical networks advising on single areas of care, and new ‘clinical senates’ providing multi-professional advice. Although the Government maintained its original target for all CCGs to be established by April 2013 it accepted the Future Forum’s recommendation that groups should not be authorised to take on commissioning budgets until they are ready and willing to do so. A 1 RESEARCH PAPER 11/63 Government amendment would replace Monitor’s duty to promote competition with a duty to prevent ‘anti-competitive behaviour’. Other Government amendments related to the duties of commissioners to promote the NHS Constitution, patient involvement, and the integration of health services (and would introduce a new duty for Monitor to act with a view to enabling the integration of services, where it would improve the quality of care). Section 1 of this paper provides an overview of the NHS Future Forum’s listening exercise and the Government’s response. Sections 2, 3 and 4 provide information about the re- committal motion and the Committee stage, including a summary of the key debates and amendments to the Bill agreed in the Committee. There are two earlier Library research papers on the Health and Social Care Bill; the first, prepared for the Commons Second Reading debate, provides more detail on the Bill, and the background to the Government’s proposals for reform (RP 11/11, 27 January 2011); the second paper provides a summary of the Commons Second Reading debate on the Bill, on 31 January 2011, and the changes made during the Public Bill Committee’s first consideration of the Bill, between 8 February and 31 March 2011 (RP 11/31, 6 April 2011). References to clause numbers in this paper relate to the version of the Bill as amended during the Public Bill Committee’s first consideration of the Bill (Bill 177); this version of the Bill, the version as amended on re-committal (Bill 221), and an illustrative version of the Bill showing the changes that were made during re-committal, are available from the Parliament website. 2 RESEARCH PAPER 11/63 1 The NHS Future Forum and the listening exercise On 4 April 2011, the Secretary of State for Health, Andrew Lansley, announced that the Government would use a “natural pause” in the legislation to conduct a listening exercise, following significant concerns about its programme of health service reforms. This followed calls from organisations, representing key groups of medical professionals, patients and policy experts, for greater accountability and transparency in the proposed system of GP-led commissioning, and demands for wider clinical involvement in decision making.
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